Provider Demographics
NPI:1366503104
Name:CENTI, MICHELLE JAGER (OD)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:JAGER
Last Name:CENTI
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:223 BRIERHILL DR STE C
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21015-4948
Mailing Address - Country:US
Mailing Address - Phone:410-420-3933
Mailing Address - Fax:410-420-6399
Practice Address - Street 1:223 BRIERHILL DR STE C
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21015-4948
Practice Address - Country:US
Practice Address - Phone:410-420-3933
Practice Address - Fax:410-420-6399
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA 1449152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist